Provider Demographics
NPI:1396936720
Name:HAGLEY-NANTON, ANTOINETTE M (MH, MT)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:M
Last Name:HAGLEY-NANTON
Suffix:
Gender:F
Credentials:MH, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E COLUMBUS DR.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605
Mailing Address - Country:US
Mailing Address - Phone:813-514-8280
Mailing Address - Fax:813-514-8281
Practice Address - Street 1:1463 OAKFIELD DR.
Practice Address - Street 2:SUITE 113
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-514-8280
Practice Address - Fax:813-514-8281
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8480101Y00000X
FLMT2140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor